Anyone who’s ever been to the physio and been given “homework” will know where I’m going with this. When you return to the physio and they ask if you’ve done your exercises or stretches, you can see that they are ready to sigh. All too often, people are “too busy” or “forget” and expect their health practitioner to do all the work for them. When in the realm of physical problems and treatments, taking a pill isn’t enough. It often requires lifestyle adjustments, such as a change to diet or exercise, or even engaging with a variety of specialist practitioners to achieve the best possible result. It requires the person to “own” their condition and work to improve it.

This is just as true for lymphatic problems. As your lymphatics interact with so many bodily systems, it is vital to explore possible interactions with your practitioner and to consider lifestyle adjustments when suggested. The patients who listen to suggestions and make changes to their lifestyles achieve much greater results than those who continue as before and come for the odd treatment.

I’ve already written about the importance of nutrition and inflammatory conditions of the gastrointestinal tract (GIT) in lymphatic drainage, it is important that people consider this, especially in the case of fluid retention in the legs. I’ve had several patients who have tested positive for coeliac, but were told that they could still eat wheat if they didn’t think it affected them. Of course, it did, just not really obviously. This is just one example – it could be all sorts of things. This is best addressed by a good doctor, naturopath or nutritionist. As are conditions that some poor ladies are lumped with, such as endometriosis that also cause inflammation the abdomen.

Similarly, I’ve found over the years that a lot of people with lymphatic problems are highly stressed and prone to over-thinking everything. Some active relaxation or meditation (not just watching telly) will often make a big difference to the level of a lymphatic problem.

But when you come for your consultation we’ll also talk about appropriate exercise levels, workplace factors, when it’s appropriate to wear compression garments and all the various things that can encourage or help fluid build-up in your tissues. If you take this information to heart and look to make positive changes to how you live day-to-day then you should achieve much better results than relying on treatment alone.

I quite often ask people about their sleeping posture, pillow and bed during a consultation, especially when other aspects of lifestyle don’t seem to adequately explain their pain or dysfunction or when they wake up feeling worse than when they went to bed. This inevitably throws the question back to me on what pillow or bed people should buy. The answer… well, there is no one answer.

Just as there are many different shapes and sizes of people, there are many beds – and that’s the way it should be. The first thing to get right is the sleeping posture. Never sleep on your belly – this leads to strained and shortened muscles in the neck and shoulders. You should sleep on back or side with the arms down – arms above the head (either under the pillow or starfish-style) lead to neck and shoulder tension. From here, you need to get a partner, friend or relative to observe you in your preferred posture.

For back-sleepers, the mattress should be firm enough so that you don’t sag in the middle, but soft enough that it fills out the small of your back and supports the full length of your legs. Pillow-tops are ideal. The pillow should support the head and neck without pushing your head forward or letting it drop back. Ideally, the forehead and chin should make a roughly horizontal line – those who hold their head forward naturally will need a thicker pillow than those with an upright posture.

For side-sleepers, the mattress again should be firm enough so that you don’t sag but also not be so firm that it’s like lying on a board. Again pillow tops are great as you can have firm springs and still be supported. When your friend observes you, they should check that your spine is roughly in a straight line. The pillow should also keep the spine in a roughly straight line without pushing the head up or letting it drop.

Things do get interesting for couples. If you have a 100kg 6’2″ man and a 50kg 5’5″ woman, then they basically need two separate beds. This will call for some compromise, but again, a pillow-top can make the difference with firm springs and a squishy layer on top to allow for difference.

If you’re in a tight space financially, you can always buy a mattress topper from Ikea or a foam overlay from Clark Rubber or even use a blanket or two to add a softer layer. A trick from hotels to firm-up a mattress is to put a piece of MDF between the mattress and base.

For the perfect pillow (or as close as you can get) you can get Sleep Made to Measure. This Sydney-based company builds latex pillows to the measurement of your head, shoulder width, sleeping posture and bed-type to give you the best possible fit for you. You can check them out at sleepmadetomeasure.com .

Plantar fasciitis is a painful condition of the underside of the foot, sometimes caused by poor footwear or excessive use. It is normally felt most at the heel and tends to be worse first thing in the morning and eases as the day goes on. Many sufferers spend a significant amount of time stretching their feet before first stepping out of bed in the morning.

So what is it? The plantar fascia is a strip of tissue that runs from the forefoot to the heel, attaching at the calcaneous or heel bone. But that isn’t the full story – if you read the work of anatomist Thomas Myers, it forms part of the Superficial Back Line of fascia that then goes on to include the gastrocnemius (in the calf), the hamstrings, erector spinae and fascia of the scalp. It runs all the way from the ball of your foot to your brow via your back. And that is why some people don’t respond to localised treatment. If your podiatrist only looks at the foot fascia, then they may miss some of the problem. It is important to release the entire line of fascia in case the problem has originated from higher up.

Plantar fasciitis (PF) is damage to the fascia that never gets a chance to heal properly as the area is re-strained daily with activity. If left untreated, it can develop into heel spurs as the body lays down bone where the fascia is pulled away from the calcaneous.

So what can be done? While I can certainly massage for this, there is fantastic work in Bowen Therapy for this exact condition. We release the whole line of fascia and also do some simple taping. The aim is to take the strain off the fascia as it heals by holding the foot in an arched shape.

I’ve had a run of people with this condition lately (as tends to happen), most of whom have flat feet. In the event that improvement is not adequate, then orthotics may be required to continue healing on a longer-term basis.

I’ve had a bit of a run of patients with problems around the shoulder area. One common cause of this is using the wrong muscles to stabilise the shoulders when using the arms. The scapula (shoulder blade) is highly mobile with bony joints only with the clavicle (collar bone) and humerus (upper arm). The rest of the stabilisation is done purely by your muscles. To get an idea of how mobile a scapula can be, just watch a cat sauntering along – the shoulder moves through quite a range.

When performing tasks with the arms – be that typing on a computer, cutting vegies for dinner, weights at the gym or boxing, the shoulder needs to be stabilised to ensure that the movement is precise and strong. If the shoulder isn’t stable then the arms will be all over the place. One of the key muscles for this is the serratus anterior. It ties the scapula to the ribs and helps to move the scapula forward and to the sides. Also stabilising the shoulder are the trapezius, levator scapula and rhomboids and it’s these I want to talk about today.

Many people, from sitting at a desk or from habit, use the upper trapezius (runs from the upper scapula up the neck), levator scapula (from the inner corner of the scapula up the neck) and rhomboids (inner edge of scapula, running diagonally upwards to the spine) to stabilise the shoulder blade. This has the effect of pulling the shoulder blade upwards towards the head, as well as back. These muscles are easily overloaded and can bring on headaches, shoulder and neck pains as well as nausea and dizziness in stronger circumstances. Next time you’re working away at the gym or cutting stuff for dinner, take a second to think about how you are using your shoulders. Do this throughout your day and see if you can establish a pattern of not over-engaging the upper muscles.

The thing to do if you do find yourself in this pattern is to strengthen the lower part of the trapezius (runs from the scapula down to the middle spine) and the latissimus dorsi, which runs from under the arm to the lower spine and pelvis. Teaching these muscles to engage draws the scapulae down and back and takes pressure off the upper shoulder and neck. At the gym, the exercises that immediately spring to mind are the lat pull-down and the seated row. With pull-downs, you grasp a bar above your head with the hands wider than shoulder width apart. You then raise your chest and pull the bar down towards your chest. As you do so, concentrate on bringing the scapula down and together. This will engage the latissimus but also the lower trapezius. Wide-grip chin-ups also perform this action. The seated row involves sitting and pulling a handle towards the chest. You must again concentrate on sitting up high and squeezing the scapulae together and down to engage the lats and lower traps.

Hopefully this helps some of you to establish some better muscle-usage patterns and avoid a pain in the neck. Bowen therapy and remedial massage can, of course, help turn off those over-engaged muscles.

The last mention of butt muscles for a while will be the piriformis. I see a fair few problems relating to this one muscle, and the end result is often sciatica. That’s an inflammation or irritation of the sciatic nerve that can come from the spinal outlets but also from direct pressure from a tight piriformis.

The piriformis attaches at the anterior surface (the inside) of your sacrum and the greater trochanter (the lump on the outside of your hip) of the femur. It essentially externally rotates the hip (turns your foot out) but also abducts your femur when your hip is bent.

Problems arise when the muscle becomes too tight. This can often be from poor habits that we get into, such as walking or standing with the toes pointing out. Be aware when doing exercises such as squats that the feet should point roughly forward and not be in a Charlie Chaplin stance. Tension in the piriformis can cause the belly of the muscle to put pressure on the sciatic nerve, which is quite thick.

In a small percentage of people, the sciatic nerve can actually pass through the piriformis muscle, heightening sciatic pain. It is important to also build the gluteus maximus to take pressure of the deeper muscles of the buttocks. Bowen Therapy or remedial massage should aid in reducing tension that is present.

The last post on the gluteus maximus naturally gives way to talking about the other muscles of the area. Today I’ll discuss the gluteus medius. This muscle sits underneath the gluteus maximus, attaching at one end to the ilium of the pelvis and at the other to the greater trochanter of the femur – that’s the knobbly bit you can feel when you stick your hip out to one side.

This muscle isn’t used for standing in the same way that gluteus maximus is. This one is essential for walking. It, together with the gluteus minimus and the tensor fascia latae, supports the body upright when one foot is raised from the ground. Essentially, it stops you from falling over to one side when walking. The action of the muscle is to abduct the femur – that is, take the thigh away from the midline of the body. It also turns the knee inwards (internal rotation) when the hip is flexed (knee raised in front) and turns the knee outward (external rotation) when the hip is extended (leg behind you).

The test for this is to get a patient standing level and then ask them to raise one leg slowly. If the opposite hip drops, it suggests a weak or impeded gluteus medius. Another sign that can be observed is the tendency to scuff the inside of the shoes. A weakness in the medius can lead to the inside of the feet rubbing past each other when walking. A tight gluteus medius will often come from activities that require one leg to support the whole person, such as in soccer when you are supporting on one side and kicking with the other.

But never fear, it’s not the end of the world. If your muscle is in spasm, Bowen therapy or remedial massage can help. If the muscle is weak, then good old clams can help to strengthen it. Lying on the floor on your side with the knees bent slightly in front of you, slowly raise the topmost knee in the air while keeping the ankles together and then close. It looks kind of like a mollusc opening and closing it’s shell. Of course, you really need to get this checked professionally and not do a Google Doctor on yourself!

Your gluteus maximus, the big outer buttock muscle, is a much neglected thing. This muscle is one of the things that keeps us upright and separates us from our ape ancestors. The development of this muscle allowed the pelvis and spine to be pulled into an upright position, and it also is important in the everyday action of walking.

The gluteus maximus attaches to the ilium (one of the pelvic bones), the sacrum and coccyx (the lowest two sections of the spine) and the femur or thigh bone. It is the larger outer muscle of the buttocks, very much what gives us that classic human shape. When standing, it helps to pull the pelvis back to keep the spine erect, but it also the muscle that helps push us from a sitting to a standing position by contracting and forcing the hip to straighten. When standing, a contraction of the muscle pulls the femur back behind the pelvis (it extends the leg) to propel us forward. That is, it makes us walk.

Like any muscle, this can go wrong. From injury or habit, it can not fire properly. In this event, when walking or running, the hamstrings and muscles of the lower spine overwork to compensate, and this can result in lower back pain or hamstring strains. I have treated ballet dancers in clinic, who are trained to not engage the gluteus maximus to avoid having a “big bum”. This can result in overuse and potential damage to the hamstrings. In others, a tight psoas can impede the firing of this muscle and have a similar result. I’m sure you’ve all seen people with little shape to their posterior, sometimes called “old man arse” where it seems a straight line from shoulder to thigh. This can be indicative of a lack of glut maximus strength and result in other problems.

This is fairly easy to remedy. If there is an issue with the psoas impeding the glut, then you will probably need some release work with Bowen Therapy or physiotherapy. Then, it’s a case of squats. If you have a trainer or go to the gym, then you can start there. A trained Pilates instructor can make a big difference. Always start unloaded, with feet shoulder width apart, and angled so that the knees track naturally over the toes. Do NOT do the Charlie Chaplin stance with the feet turned out. Lift the chest and pull the navel towards the spine to engage your core. Then bend the knees and allow your top half to lower. When you are as low as is comfortable (preferable with thighs parallel to the ground), squeeze your butt and push yourself upright. Try to push down through your heels to make sure your gluteus maximus is doing the work and not your quads. Use your mirrors to check the posture.

If you aren’t a gym goer, don’t give up. You can do simple squats with a fixed chair. Adopting the above posture, simply lower your bum until you tap the seat, then, without lingering, squeeze your butt to push yourself upright. Come to a set of stairs? Think of squeezing that butt as you ascend. Don’t pull yourself up with your quads, push yourself with your gluteus maximus.

We can’t all be bootylicious, but we can keep our muscles working as they’re intended.

I’ve had a few people in with shoulder problems related to their rotator cuff. I’ve found injuries always come in “runs”, so I thought this’d be a good time to briefly discuss the group. A lot of people are diagnosed with a rotator cuff tear or dysfunction without anyone ever really going into what is happening or even specifically which muscle is involved.

The rotator cuff is made up of four muscles that both stabilise and move the shoulder joint. The glenohumeral (shoulder) joint is not overly stable due to the very shallow socket of the glenoid fossa but this is what allows the huge range of motion in this joint. As a result of the shallowness and instability, the muscles that cross the joint aid the ligaments of the area in strengthening the joint. Direct impacts to the shoulder or falling on an outstretched hand can easily dislocate or strain the joint damaging both ligaments and the tendons of the muscles.

The rotator consists of: the supraspinatus, which abducts (raises to the side) the arm; the infraspinatus and teres minor muscles, which both externally rotate (turn the hand palm out) the arm; and the subscapularis that internally rotates (turns the hand palm in) the arm.

Many of the patients I see with problem are troubled by having their arms stretched out for long periods. Hairdressers are commonly affected by having their arms at shoulder height all day. People who drive with extended arms and similarly people who work on laptops or with the keyboard pushed too far away can also experience problems. From a sleeping point of view, sleeping with your arms above your head can leave these muscles in spasm.

Most tightness and spasm will react well to Bowen therapy or remedial massage, however tears may need to be referred on to a surgeon depending on the grade of tear and any instability in the shoulder. Stretching these muscles isn’t overly easy due their attachment to the highly mobile scapula but there a few things that can be done.

I’ve had a few sciatica patients in the last little while, so I thought it’d be a good time to talk briefly about it. Sciatica is pain brought about by impingement or irritation of the sciatic nerve. It can manifest as pain anywhere from the buttock (and even lower back) to the foot and may produce neural symptoms in the foot (pins and needles etc). While this can result from injuries or structural problems in the lower back, by far the most common cause in my clinic is from piriformis syndrome.

Briefly looking at the anatomy of the nerve and surrounding tissue, the sciatic nerve originates from several nerves of the lower lumbar and sacral spine joining together. This nerve then comes from under the sacrum and passes almost vertically down, deep in the buttock. It continues down the rear of the leg innervating the back of the thigh, the entire lower leg and most of the skin on your leg.

Impingement of the nerve can occur at the spinal outlets from disc compression (bulge/herniation/degeneration) or from conditions such as spondylolisthesis (backwards or forwards displacement of the vertebrae). Downwards pressure of a swollen uterus during pregnancy can also cause it. The cause I see most frequently is referred to as piriformis syndrome. While the sciatic nerve passes almost vertically, the piriformis runs almost horizontally from the sacrum to the greater trochanter (that lump on the side of your hip) of the femur. The muscle sits adjacent to the nerve and in some people the nerve actually passes through the muscle. These people are particularly prone to piriformis syndrome. The upshot is that a tight piriformis can easily compress the nerve producing pain and nerve-related symptoms like pins and needles. Over a period the compression can lead to inflammation that can take time to recede.

The piriformis is used by your body to laterally rotate the femur – that is, turn your foot out. This will give some idea of things that can cause tightness. Do you walk with your feet turning out? Do you do squats with the feet turned out? These sort of activities encourage the tighening and shortening of the muscle and increase pressure on the nerve. It pays to keep the gluteus maximus (the big outer bum muscle) strong to take pressure off the deeper muscles.

Remedial massage and Bowen Therapy are both great for this, although Bowen has the advantage of being non-inflammatory. If the body is non-responsive after one or two sessions then scans may be required to check the health of the intervertebral discs and refer on if there is a problem.

I’ve noticed that quite a few patients coming in with fluid retention in the legs or bloating in the belly have a common factor of gastro-intestinal tract (GIT) problems. This can be anything from a food intolerance (often the usual suspects of wheat, dairy, yeast and fructose) to more serious conditions such as colitis and Crohn’s disease.

Why is this? Well, for those unfamiliar with the lymphatic system, the lymphatics empty back into your blood in the sub-clavian vein (in most people) near your clavicle or collar bone. This means that all lymphatic fluid in your body must make its way back to your neck. As the lymphatics have a large role in immune response and an allergic reaction or auto-immune problem is based in the immune system, this will lead to inflammation and various white blood cells and pro-inflammatory factors rushing to the gut. This clogs everything and water comes to surround the proteins in the immune reaction. The result is a bloated tummy and possible back-log right down to the ankles as the fluid from your legs must make its way through the abdomen to the thoracic duct under your sternum. You can think of it as trying to get out of a shopping centre car park at 5 when the shops shut. There are limited exits and all lanes feeding to them. The traffic jam eventually passes right back up to the other levels of car park.

Working with a naturopath or nutritionist can help you to understand food allergies and there are treatments, both medical and herbal, for inflammation of the bowel. Manual lymphatic work can help to clear out the old blockage and free the flow again. Obviously this isn’t the case with all lower body blockages – some are from surgery (C-section, appendicectomy, cancer, traumatic birth, varicose veins) and congenital causes, but it certainly makes a difference to a vast number of my patients.